Sunday, August 29, 2010

One of the highlights of my trip to Pakistan was a trip to a maternity home in Karachi.

Maternity UnitIt is a small unit with about 120 births per month. The unit is an old building which is currently being renovated. So what with all the noise, dust and the heat, it is not a comfortable place to work and live. The care provided is mostly primary care - women whose pregnancies become complicated are transfered to the bigger hospitals in Karachi.

PoliticsThe local community is a poor one, and beset with political strife. Whenever the local political parties have a falling-out, someone gets shot. This poses additional security probems to the staff who work in the hospital. Many staff commute at least an hour daily to the hospital. They do not feel safe to live in the community, but they are very committed to working in the hospital. The local community wants the maternity unit because many of them cannot afford to pay for care in the bigger hospitals.

Midwifery education

The midwifery students and educators are similarly dedicated. The educators work six days per week...three teaching and three days working in the hospital. When they are done for the day, they go home and look after their extended families...study...and do voluntary work in their communities. They are wonderful young women and a real credit to the midwifery profession.

Midwives are well regarded in the community, and I think a midwifery caseload approach will go down really well with the women. Now, Rafat and her team have to work out how a midwifery 'continuity' model will work in Pakistan.

Community feel

I really liked the hospital. Clearly, it has huge challenges and the working conditions are far from ideal. But the community feel of the place and the dedication of the staff set us all an example to aspire to.

Thursday, August 26, 2010

One of the main reasons I am at the Aga Khan University in Karachi is to help Ass. Prof Rafat Jan look at the current midwifery curriculum and think about where to take it in the future.

Diploma to Degree

At the moment there is direct entry into a midwifery diploma course which takes 15 months. The aim of the midwifery educators here is to take education to degree level over three years so that it becomes more consistent with other countries, and to raise standards overall.

Too young?

One of the problems they face is that they have the exact opposite age proportion to us in New Zealand - our average age is 45...the midwives here are very young...many start their education at 16 years. Doctors find it very difficult to trust and work with midwives who are so young.

Autonomy

The other problem the midwives have is that the maternity system is very 'hospital' focused which means experience is fragmented - midwives do not carry caseloads, and it is difficult to teach full scope of midwifery practice. Doctors make a lot of the decisions and catch the babies...a similar situation to Australia in the private sector. So education programs needs to provide full theory and clinical experience which is woman-focused, rather than systems-focused.

Small businesses

The interesting thing is that midwives are being funded to set up small maternity units as a self-employed business. So I think there is a real opportunity to get women on board. If students follow women through the pregnancy and birth, similiar to the New Zealand model, I think it will not take long for women to see the advantages of continuity...just as they have in other countries. Midwives still have to face the perception that the 'doctor knows best', but as women start to experience midwifery care, I am sure midwives will come into their own.

What can we do to support Pakistani midwifery educators?The main thing we can do is to share our ideas and experiences, curriculum and teaching resources so that educators in developing countries are not wasting valuable time re-inventing the wheel. I know that they will have to turn things into their own context, but basic midwifery principles are the same the world over.

If you are a midwifery educator and you will like to know more about how you can support midwifery education in Pakistan, please let me know and I will forward your details to Rafat and her team.

I was thrilled to get the chance to watch a local cricket match on Sunday, and see a national player, 'Boom Boom' Afridi take the crease. I was rather nervous about the whole affair because while I had been taken by a local family and was wearing my Pakistani clothes, I was conscious that I was the only woman...and a European woman at that. I became even more anxious when one of the children insisted I took her to get Boom Boom's autograph. But in the end, I decided to use my pushy European strategies and push ahead of the crowd...all very enthausiastic men....stepped on a few little adoring boys, and we got his autograph. Needless to say, the little girl was very impressed with what we managed to achieve. I got the impression I was able to push ahead because I was an elderly 'Aunty'....now that has really upset me!!

Wednesday, August 25, 2010

I have already talked about the warmth and generosity of the people I have met here in Karachi. But the news is currently full of a story that has shown the very brutal side of Pakistan that has shocked people here and plunged them into sadness...as if they do not have enough to cope with.

Two teenage brothers, 15 and 17 years old, were in the wrong place at the wrong time. They were tied up, brutally attacked and tortured to death by a crowd of people. The most shocking part of this story is that the police stood by and even aided the crowd to carry out this atrocity...this has come to light because videos were made of the killings. The police have been identified and currently are being held for trial.

I was horrified by this story but have no right to comment when I think of the horrifying things that happen in New Zealand...like the torture and killing of the Kahui twins...an act that still goes unpunished by law.

The comment I will make is that modern technology may have a profound effect in places like Pakistan ...such as having the ability to make a video with a cell phone and rapidly disseminate information by social media. People have told me that they feel this will open up society and drive the move to greater democracy....time will tell if this is the case.

Here are some free online tools that can be used to support teaching, presentations, collaborations, sharing and organisation of resources. When you using, creating and sharing free online resources you need to consider issues of copyright, so check what licence the resource has eg does the resource have an 'All rights reserved' licence or 'Creative Commons'.

Suffice to say, the news in Pakistan is totally focused on the floods in the country. The latest I have heard is that 20 million people are homeless. At this stage, the death rate is just over 1,000 people but I am guessing that that will increase substantially as babies, children and the elderly die from dehydration, starvation and gastro-enteritis. Even though Karachi has not been affected by the floods, the flow-on effect will be felt as refugees make their way to Karachi.

I get the sense that international aid has been slow to make its way to Pakistan because of concerns that aid will be lost to corruption. I also think that Pakistan has an international profile that does not render sympathy. Nevertheless, it is heart-breaking to think of the vast number of people who have been left with absolutely nothing.

I have talked to Rafat about how assistance can be given to the mothers who are about to give birth in the next three months...a figure of about 100,000. But at the moment, there are only eight refugees in Karachi who are due to birth in the next wee while. And these women are extremely high risk because they are so anaemic. So the plans for a maternity facility for refugees in Karachi have been put on hold.

Friday, August 20, 2010

I wasn't sure what to expect when I got to Pakistan but what I have found is amazing warmth and hospitality.

Preconceptions

I'll be honest, I was in two minds about coming here. You hear so much in the Western media about the violence in this area, and the hatred that Muslims have for people from the Western World, especially if they are Christain. So I was nervous about what I would find once I got to Karachi.

A wonderful welcome

What I found found is people who could not do enough for me - I am being treated like a queen. I feel incredibly honoured to have been given the opportunity to come to a country that has such a different culture. And I know the experience I am having now will stay with me for ever for all sorts of reasons....more about that in blog posts to come.

Ramadan

I am staying and working in the Aga Khan University in Karachi. Dr Rafat Jan is responsible bringing me over, and her staff are taking very good care of me. I have to laugh because the girls are very worried I am going to starve because of Ramadan, so they keep plying me with food. So my plan for losing weght is coming to nought...I'm going to go back to New Zealand fatter than I ever was!

New clothes

As I mentioned before, Rafat and her team have had two traditional outfits made for me. I was taken to a tailor, who was very polite and didn't faint with shock when he took my measurements! I would never have found the tailor's shop in a month of Sundays. Amber took me up several flights of stairs in a rather dingy building. It was dark...lots of flys buzzing around suspicious looking objects....men staring at us as we passed. I was very glad Amber was with me because I would have felt extremely nervous by myself.

New but old friends

The other thing that makes me laugh is that Rafat introduces me as the person she met by way of Internet dating. I know there are many people who believe true friendship cannot be formed on the Internet, but my experience contradicts that. Rafat and I have been talking, mostly via Elluminate, for nearly three years and when we met on Tuesday, it felt as if we had known each other for years.

Surreal experience

Living here on the university campus is a surreal experience. It feels very 'civilised' here. The buildings are beautiful. Clearly the people who work here are well off...or at least the academics, nurses and doctors are. Yet, just down the road there were riots last night and several people were killed. The city is currently holding its breath to see if more violence breaks out. I know there are refugee camps here, filled with displaced people from the floods. I also know there is terrible poverty, sickness, drug problems and so on here in Karachi. But here I am...sitting in my air conditioned room...linked up to very fast Internet...sending my tweets on Twitter and writing this blog post.

Two different worlds......just metres apart.

If you're interested, keep an eye on my YouTube and Flickr pages for more photos and videos about Karachi and my adventure here.

One of my remits while I am here in the Aga Khan University, is to work with the Nursing and Midwifery Faculty to explore eLearning, how to construct online courses and to support staff to get a sense of some of the online tools that are available.

WorkshopsSo far I have run two workshops - one was a computer session looking at online tools that can be used for collaboration such as wiki, Google Documents and Delicious. And yesterday, I facilitated a more formal session looking at how to construct online courses.

I have never been one for drinking water - much prefer tea - but in the computer session I drank four litres of water...and there wasn't much that came out the other end! So I am finding these sessions are really tiring me compared to how I'd feel if I was leading them in New Zealand.

Willingness to learnWhat I am really enjoying is the engagement with the nursing and midwifery faculty staff. They are very keen to learn but at the same time, have a very astute take on things and totally get the concepts I am trying to put across. They are very open to new ideas and very happy to get stuck in with the computer skills...they do not appear to be so afraid of computers and the Internet compared to the staff I usually work with. But I should also say, they are much younger than the staff I usually work with, so I am wondering if that is making a difference.

IT policiesI am also very impressed with the attitudes of the IT staff. I have been surprised at how open the Internet system is at the university - I have not come across any restrictions to sites like YouTube or Facebook, and there was not even a whimper when I asked for Second Life to be downloaded on the laboratory computers...unlike some institutions I could mention in New Zealand.

Different yet the sameWhat has struck me is how similar we are in the educational issues we face, both in Pakistan and New Zealand. We both have limited resources, yet a need to provide more flexible education. I know Pakistan have far more serious issues with access and equipment, but it is something we need to think about as well in NZ. I do think that mobile learning is a very real option for Pakisatn, because even very poor people have cell phones. Nevertheless, it is clear that there are many, many people who will not even have access to rudimentry education....all they are worried about is surviving from day to day. This makes me feel very helpless but also very grateful about the life I live, and reminds me not to take anything for granted.

Next weekNext week I am doing another couple of workshops about using social media for teaching and learning, and then looking at free tools that can be used for presentations etc such as Animoto. I am also having some free sessions where I do one-on-one work with people to discuss their work and anything they want to learn.

Wednesday, August 18, 2010

My first impressions of Karachi are that it's a wild, crazy, frantic place...full of energy...a place of contrasts.

Taking my life into my handsThe first thing that struck me was the traffic. If you want an adrenaline buzz, don't waste your time bungy jumping or sky-diving...all you need to do is get in a car, or better (or worse, depending on your point of view) a scooter and drive down the main streets. Everyone is rushing around in different directions...amazing speeds...honking their horns and determined that they will not be the one to get out of the way. Whole families take their lives in their hands on one scooter...with no crash helmets. I tell you...taking a drive is more fun and more terrifying than the fastest roller coaster at Disney World.

SafetyWhat I have seen of Karachi has been mostly by car. There are areas of the city that are not safe to go. And it is a little intimidating to see soldiers and security men around with guns. But I do not get the sense the place is under lock down. I would not go anywhere on my own, but I feel very safe when I am escorted by the folks here.

I would like to take photos because I know people back home will be interested to see where I have been, but I am very wary and not wanting to attract attention. I hope to get some photos when I go out sight-seeing at the weekend.

ShoppingOn the first day I got here I was taken shopping...these women I am working with are women after my own heart! They have bought material to be made into two Kameez Shalwar for me. I just adore the colours that the women wear - so pretty and far more colourful than the clothes we wear in New Zealand. Wearing a Kameez Shalwar will make me feel a lot less conspicuous when we go out and about.

FoodThe food is fabulous. I thought I would find it too hot and spicy but it is what I am used to eating when I go to an Indian restaurant in New Zealand, or when my husband cooks a curry at home. It is Ramadan at the moment which means people fast during day light hours. This hasn't been a problem for me because I have been given lots of fruit to eat during the day - I've got a whole fridge full of mangoes. The thing I focus on is drinking plenty of water so I don't get too dehydrated. It is very hot and muggy here, but the air conditioning stops me getting too hot. The main thing I have noticed is my feet are swelling up which is really uncomfortable - I'll have a lot more sympathy for people with oedema from now on.

AccommodationI am staying in the woman's hostel on the campus of the Aga Khan University. It is extremely safe with lots of security guards. I am totally happy now I have full Internet access. I've already had chats with people from home on Skype and Gtalk - it is lovely to know people are thinking of me. And of course, regular Facebook updates are obligatory these days.

Everyone has been extremely kind and welcoming and have bent over backwards to make sure I am comfortable. In my next blog post I tell you more about what I am doing while I am here.

Tuesday, August 17, 2010

I have made it safely to Pakistan, and am settling very well into life at the Aga Khan University, Karachi.

The journey over from Dunedin to Karachi was long but very uneventful. Those of you who know me well know that I have a wee problem with snoring. So my main concern with the travelling was that I'd get kicked off the flight for my terrible snoring. All I could think about was how on earth I could stay awake for 15 hours or more...through the night...without falling asleep.

Thankfully, it was my hubby who gave me invaluable words of wisdom that stayed with me on my journey..something like Master Po would say to little Gasshopper (for those of you who used to watch the TV series called "Kung Fu".

"Sarah", he said, "Don't worry about your snoring. You don't know the people on the plane and you'll never meet them again".

So...to all those on Emirates flight K600 from Christchurch to Dubai...I am really sorry if I really annoyed you with my snoring! The only people I am not apologising to is the couple with the screaming two-year old behind me...my snoring was my way of getting my own back!

Sunday, August 15, 2010

I am in two minds about this trip. It seems incongruous to be going to Pakistan to teach educators about YouTube and Second Life when there are at least four million people homeless because of floods.

The highlight of the trip will be meeting people I have been talking to online for several years. And of course, when any midwives get together, there is always fun and laughter. I know I am going to learn heaps and be completely awe-inspired by the amazing midwives I meet along the way.

Tuesday, August 10, 2010

I have been honoured to have been invited to the Aga Khan University in Karachi, Pakistan. I will be working with the Faculty of Health and Ass. Professor Rafat Jan to look at e-learning in the midwifery program. I am leaving New Zealand on the 15th August and get back on the 30th August.

We have planned four outcomes from my trip:

1. Provide information about how midwifery education is provided in New Zealand, focusing at blended delivery and elearning models that could be transported into the Pakistan context.2. Provide information about eLearning models, theory and tools that can be utilised in the Pakistan context: -

As you can see, life is going to be very busy. But I have a couple of days off so I hope to do some sight-seeing and get a feel for the culture in Karachi. I am a tad nervous about going in view of security, but Rafat managed to twist my arm when she told me the shopping was superb.

I've had a jab for every complaint under the sun and been given strict instructions to avoid cuddling dogs (and men) that are foaming at the mouth. I will be there during Ramadan, so what with fasting all day...and catching the "Karachi Trots", I am hoping to come back three stone lighter!!

I would love to hear from anyone who has been to Karachi and Pakistan - what would you recommend I do and see when I am there? What tips about safe travel would you give me?

Sunday, August 8, 2010

One of the things I've been trying to sort out in my head is how you define experiential learning. Until recently I thought of it as the learning students do when they are out on a placement...for example...when a student midwife is working with a midwife on a maternity unit.

Classroom learningWhat I have come to realise is that experiential learning is more than that...it is bound up with the activities that teachers embed in their teaching. You can have an experience and learn from it...in the classroom...as well as out in the world. The challenge for us as teachers and facilitators is to design authentic activities in a way that students feel safe and supported, but have learning outcomes for students.

Learning about online facilitationI am currently facilitating the online course "Facilitating Online". A large part of the learning of the course is the facilitation of an event. Historically, this has been at the end of the course. Participants have really benefited from the experience but it is always chaotic and quite traumatic for some people. And I have always thought that it is a shame that the course ends with this experience. I am of the opinion that it would be more empowering if participants get the traumatic stuff out of the way as they go along, and end the course on a confident and competent note.

Learning as we go alongThe value of experiential learning within a program was brought home to me on Friday. Two of the course participants, Chris and Jillian facilitated this week's live session. The session had a few hiccups so I was able to explain both to them and the rest of the group how to solve them. We were able to learn about facilitation by watching what Chris and Jillian did. And were able to learn from their reflections of how things went and the tips they have developed.

What goes on unseenThe other thing I did, which was a spur of the moment thought, was to make a few of the others 'staff members' in Elluminate so they could see what was going on behind the scenes. This may have been a little off-putting for Chris and Jillian but I think it was fabulous learning for the others. I think I'll do this every week.

What I learnedIt was important for me to pay attention so I could help Chris and Jillian when they didn't know what to do. And it was really hard for me to sit on my hands and not interfere. But Chris and Jillian brought home to me how important it is to be organised and professional in your approach to facilitating online live sessions.

Chicken and eggBut I have been left with a question to ponder by Carole McCulloch who asked in a course email if I had a framework for scaffolding students into facilitating of live sessions. The course is a framework for online facilitation but isn't complete until the end of the course. So in effect I have thrown participants in the deep end before the theory. I feel it's a bit of a 'chicken and egg' scenario - what comes first...the practice or the theory?

Emerging frameworkWhat I see happening is a framework emerging from the participants, from their experiences and reflections of worked and what did not work.

What is your experience of experiential learning, both as student and teacher? What do you think about an emerging framework developed from students' experiences? Is it fair to drop students in the deep-end like this and expect them to develop their own framework? How can I support participants' so they learn as they go along but are well scaffolded as they go?

Friday, August 6, 2010

Here is a list of some free online seminars coming up over the next two weeks. These seminars are being offered as part of the 'Facilitating Online' course, but are free and open to anyone wanting to attend.

Tuesday, August 3, 2010

It takes a lot to inspire me these days because I've been around the blocks a few times and have got a bit cynical in my old age. But I became quite teary when I listened to the presentation given by Amanda Perkins on the Virtual International Day of the Midwife about the maternity services in Romania. The conditions women live and birth in, and the challenges they face are appalling. 7 out of 10 pregnancies end in abortion. Maternal and fetal mortality is five times higher than other European countries.

What is special about Amanda is the work she has achieved in a Romanian maternity centre ....as a student midwife! She truly is an inspiration to us all.

Monday, August 2, 2010

One of the most useful sessions I attended on the Virtual International Day of the Midwife was Laureen Hudson's presentation about how to use social media. Obviously she was addressing midwives, but the advice she gave has relevance to anyone wanting to how to effectively use tools such as a blog or Twitter account.

Laureen saysIt’s not enough to just have online accounts everywhere; you need to have a voice that is unique to you, that gives value to your readers. The way you present yourself online can serve as a sterling reference or as a shocking warning, depending on how you do it.

The advice she gave that stuck in my mind was that you should publish a blog post at least three time a week and send a tweet from Twitter at least four times per day if you want to establish an online following.

Sunday, August 1, 2010

I have just been interviewed by Animoto for their latest business newsletter, which was fun. In it I talked about how we can use digital and social media - the article has businesses in mind, but the information is pertinent to all of us.

Sarah Stewart

Welcome to my blog which is a mix of talk about stuff that takes my fancy. My views are my own and not necessarily of my employer, the Australian College of Midwives. I am always really interested to hear your thoughts and feedback, so please feel free to leave a comment at any time.